HomeMy WebLinkAboutOctober 30, 2008MOBILE HOME STATEMENT OF MONTHLY PARKING PERMIT FEE
INSTRUCTIONS ,R~GE1~1E~
MOBILE HOME PARK OPERATOR (or owner of land if mobile home subject to fee is located outf~pam lete
Section Awith mobile home owner. Submit in duplicate to your local Assessorwithin 5 days of the arriv f ea
~~e.
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ASSESSOR: Complete Section B. Determine the fair market value of the mobile home. (Use PA-117~e ~ome Valuation
Worksheet). NOTE: Exempt furnishings must be subtracted from the fair market value if included in that figure. Submit form
to local Clerk for computation of parking permit fee.
CLERK: Complete Section C.
SECTIf~N A _. ,.
_..
TAXATION DISTRICT SCHOOL DISTRICT COUNTY NAME OF MOBILE HOME OyJNER
NAME OF PARK RESS OF MOBILE HOME (~
TO BE Q ,~ ~ ~ ~ ~ '~ C
COMPLETED PARK ADDRESS ARRIVAL DATE OWNER PERMANENT ADDRESS
BY ~ ~ ~ ~~
PARK MOBILE HOME DESCRIPTION .
OPERATOR MANUFACTURER'S NAME MODEL OR POPULAR NAME SERIAL NUMBER
AND
MOBILE
HOME
OWNER
ASSESSOR
CLERK
PA-178 (R. 12-04)
YR OF MANUFACTURE PURCHASE YEAR PURCHASE PRICE PURCHASED AS WHERE PURCHASED
SECTION.:G= GOMPUTATION'OF PARKii
^ NEW ~ USED
DO YOU HAVE LICENSE NO. (IF APPLICABLE) WIDTH LENGTH WEIGHT COLOR
NO.OF AXLES
BILL OF SALE TITLE
NO.OF ROOMS DOES MOBILE HOME HAVE FT. F7,
BATHS BDRMS ^ SKIRTING ~ FIREPLACE ~ PORCH
AIR CONDITIONING ~ WASHER SF
~ PATIO
TOTAL ROOMS ~ DISHWASHER SF
DRYER ~ CARPORT
PLEASE S ATURE OF MOBILE HOME OWNER
SIGN HERE' 1 ' SF
,
~!~ DATE
~
SECTION B -.VA LUATION
1. Total Fair Market Value ............ $ DATE VIEWED OR INSPECTED
2. Exempt Furnishings ............... - $
3. NET FAIR MARKET VALUE ..... $ SIGNATURE OF ASSESSOR
(Subtract line 2 from line 1)
_. '
i
4. Net Fair Market Value (from line 3 above) ..................
.... $
5. % Level of Local Assessment .......................................
(established `or preceding Jan. 1 assessmen') X
6. Value for Fee Computation (multiply line 4 by line 5) .... $
7. Net Tax Rate (after state tax credit)
(established for preceding January 1 assessment) .,,,,,,,, ~(
8. Annual Fee (multiply line 6 by line 7) .............................. $
9. Gross Monthly Fee (divide line 8 by 12 months) ............ $
10. Lottery Credit (if applicable) ......................................... -$
11. Net Monthly Fee (subtract line 10 from line 9) ................ $
PERMIT FEE
The first monthly fee
covers the month of
(Enter month)
and is due on or
before the 10th day of
(Enter the fogowfng month)
The monthly fee is
due on or before the
10th day of each
month thereafter.
Wisconsin Department of Revenue